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Equine Medicine and Surgery > Lecture 19: Orthopedic Infection > Flashcards

Lecture 19: Orthopedic Infection Flashcards

(56 cards)

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1
Q

What are the clinical signs of orthopedic infection

A
  1. Lameness- progresses to NWB
  2. Swelling- synovial effusion, periarticular swelling
  3. What
  4. Maybe fever
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2
Q

S type synovial infection infects where

A

Synovial membrane/fluid

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3
Q

Where are S-type synovial infections commonly

A

Larger joints-stifle and tarsocrural

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4
Q

Where do E type epiphyseal infections infect

A

Synovial and Subchondral bone

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5
Q

Foals with E-type infection usually have a history of ___

A

Failure of passive transfer

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6
Q

Where does P type physeal infections infect

A

Primary infection of long bone but can extend into joint

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7
Q

What type of orthopedic infection is this

A

S-type (normal rad)

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8
Q

What type of orthopedic infection is this

A

E type.

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9
Q

What type of orthopedic infection is this

A

P type

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10
Q

What is the synovial fluid cell count in S type

A

> 50k cells/uL

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11
Q

What is synovial fluid total protein of S- type

A

> 2g/dl

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12
Q

Which type of septic arthritis has no bony abnormality on rads

A

S-type

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13
Q

What are some signs of S- type septic arthritis in foals

A

Lameness, joint effusion, fever

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14
Q

What are some signs of E-type septic arthritis in foals

A

Lameness, joint effusion, fever, hyperfribrinogenemia

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15
Q

What is affected on rads for E- type

A

Subchondral bone lysis

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16
Q

What are some signs of P type septic arthritis in foals

A

Lameness
NO JOINT EFFUSION
Periarticular edema
Hyperfibrinogenemia

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17
Q

What do rads show with P type

A

Bone lysis around and widening of growth plate

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18
Q

What are some diagnostics for all 3 types of septic arthritis

A
  1. CBC/chem, SAA
  2. Radiograph- all enlarged joints
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19
Q

What is the gold standard for diagnosis of S and E types

A

Positive culture

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20
Q

Why do positive cultures only occur in 50% of S and E types

A

Synovial fluid is very resistant against bacteria

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21
Q

Ultrasound of joint, what wrong

A

S and E types- septic arthritis

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22
Q

What is systemic tx for S and E types

A
  1. Broad spectrum antibiotic- K Pen-Gent
  2. Anti-inflammatories- banamine
  3. Ulcer prevention
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23
Q

Off NSAIDS for __hrs before discontinuing antibiotics for S and E types

24
Q

What are local tx for S and E types

Study These Flashcards
A
  1. Collect culture before treatment if possible
  2. Joint lavage- 1-3 liters fluid and leave antibiotic (amikacin)
  3. Antibiotic tx- regional perfusion, PMMA beads, R gel
  4. IA hyaluronic acid
25
What are R-gels
Can combine with antibiotics and make it last for 2 weeks
26
T or F: you can put steroids in a septic joint
False- NEVER
27
What is systemic treatment for P type
1. Broad spectrum antibiotic 2. Banamine 3. Ulcer prevention
28
What is local treatment for P type
1. Collect culture before treatment 2. Antibacterial therapy- regional perfusion, PMMA beads, R gel, inject lesion
29
How do you do an IV regional perfusion
1. Apply tourniquet 2. Inject 50cc slowly via butterfly 3. Leave 30 mins 4. Treat vein topical with anti-inflammatories (DSMO)/bandage
30
What are some treatment options for E and P types
1. Surgical debridement 2. Abx therapy 3. Repeat joint lavage for E-type
31
What types are these
P type
32
What are PMMA beads (polymethylmethacrylate)
Beads you can add antibiotics to and they diffuse over long periods
33
What structure in foals do you also need to look at for cause of septic joints
Umbilicus
34
If you can’t lavage joint what do you do
Arthroscopy
35
what’s wrong
Synovitis- fibrin accumulation
36
Septic synovial structures in adults most commonly occur following __ or __
Puncture wounds or injections
37
What bacteria are associated with puncture wounds causing septic synovial structures
Enterobacteria, staphylococcus, pseudomonas
38
What bacteria are associated with post injection septic synovial structures
Staphylococcus
39
__spread is rare in adults
Hematogenous
40
In adults with septic synovial structures spread of infection from ___ to ___ occurs
Bone to joint
41
Septic tenosynovitis is commonly from ___
Lacerations
42
Simple lavage for septic tenosynovitis is often less effective than in joints so you should do __ or ___
Tenoscopy, synovectomy
43
Septic tenosynovitis often require __ and ___into bandage
Drainage and lavage
44
What is Sequestrum
Trauma to the bone that results in disruption to periosteum which disrupts blood supply to outer 1/3 of cortex, leads to a vascular necrosis and bone dies
45
With a Sequestrum a ___forms exiting the skin
Draining tract
46
What should you suspect in chronic non-healing wounds over bones
Sequestrum
47
what is wrong and label arrows 1-3
Sequestrum 1. Sequestrum 2. Cloaca 3. Involcrum
48
What is conservative treatment for Sequestrum
Long term antibiotics
49
What is sx tx for Sequestrum
Debridement and removal Wait for it to loosen
50
___is a major consideration in fracture repair because lots of implanted material and long surgery times
Post-op infections
51
What do you do to prevent post-op infections
Prevent during sx- prophylaxis antibiotic and lavage sx with abx containing fluids
52
What is tx for post-op infection
1. PMMA- under plate, mixed with amikacin
53
What signs lead to diagnosis of post-op infection
1. Lameness 2. Prolonged discomfort despite analgesics 3. Persistent swelling and inflammation 4. Drainage 5. Fever
54
How do you tx infected implants
Systemic and local antibiotics
55
If implants are unstable how do you tx infected implants
Remove, debridement
56
If implants are stable how do you tx infected implants
Leave in, continue antibiotic therapy and once bone heals remove it

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